peds ch 2 normal dev

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peds ch 2 normal dev
2012-01-31 09:16:12
peds normal dev

peds ch 2 normal dev
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  1. Human development is orderly and predictable
  2. there are individual differences and variations
    age of walking vs age of talking

    • which comes first
    • adolscence-onset of menstratuation
  3. orderly and predicable
    prerequisites for development

    if a child cannot sit independently, will he be able to walk?

    bases for treatment

    processes which are biologically programmed and yet can be changed via interaction with the environment
  4. patterns of development

    • control of movement develops head to toe
    • gain control ofneck before trunk before extremities

    • ex. sits before stands
    • crawls before walks


    • near to far
    • gains control of trunk before extremities



    • mass reactions-specific
    • general-controlled

    ex. baby sees something he wants-pleasure is expressed by eye widening, wiggleing, arms waving (total body mov't)

    older child see something he wants-he will smile and reach for the object

    simple to complex

    • ex.language development
    • hand development
    • gross raking grasp-palmar grasp-lateral pinch-pincer grasp

    single sounds-blending sounds-words-sentences
  5. gross motor to fine motor
    child develops gross motor skills before fine motor skills

    ex. moves arm-swats toy-pick upp large objects-picks up small objects
  6. dBasic premisevelopmental approach
    1. human beings normally develop in a sequential way

    2. each new gain in structure (physical or mental) enables the individual to gain in function

    3. each new gain in functional ability makes further development and adaptation possible

    4. physical, sensosry, perceptual, cognitive, social and emotional aspects of the individual are intimately connected and affect the developmental state of the whole individual

    5. conditions of stress cause the stressed individual to regress to earlier levels of adaptation

    6. successful experiences foster a sense of wholeness and competence
  7. therefore, a therapist must
    provide success experiences by meeting the clients elvel of adaptation

    encourage 'safe' exploration and practrice as the client enables to move to more mature levels of adaptation

    provide opportunities for challenge, surprise and novelty when the client is ready
  8. developmental sequence
    1. a normal baby doesnot develop head control in prone-head control develop ina vertical plane while being held

    2. head control develops as a result of a balance between flexors and extensors

    3. vertical, horizontal, and diagonal control can develop in any sequence

    4. vertical control is not complete before horizontal control begins to develop. Development of vertical, horizontal and diagonal control overlaps.

    5. once midlein control develops-then control of the sides develops and then dissociation of one side from the other
  9. midline control
    1. symmetrical control

    • both sies do the same thing
    • mirror motor act(opposite)

    2. bilaterality

    each side does someething different

    need the rotational component to gain control

    3. dissociation of movement

    • upper extremitiesfrom lower extremities (top from bottom)
    • pull to stand
    • flexion of upper extremeities
    • extension lower extremities
  10. development of movement
    • 1. the infant starts by moving and then sensory input modifies the movement
    • motor-sensory-motor
    • ex. wear nightgown to bed and is just doesn't feel right, get up and change

    2. reflexes are present to provide more movement

    gives the baby control and movement when he doesn't have it.

    • 3. mass patterns of movements to more isolated movements to refined movements
    • mass-isolated-controlled

    4. muscle tone (resting tesnions of the muscle) develops from the feet to the head-prenatally

    5. muscle control develops from the head to the feet and proximal (center) to distal (outward/extremities) after birth
  11. development ofmovement(continued)
    6. infants start out in physiological flexion

    • 1st movement is extension
    • shortly after birth,controlled flexion begins
    • flexion/extension of neck is initially asymmetrical
    • flexion/extension of neck become symmetrical with midline orientation

    extension control develops faster than flexion control

    flexion/extension working on opposite sides of the body=rotation with the body axis

    diagonal pattern
  12. development of movement(continued)
    7. different interaction of muscle groups creates different movements

    8. as trunk gains control,the same flexion/extension control needs to develop in the extremities

    front/back rocking on extended arms and knees=flexion/extension

    weight bearing-side to side shift-abduction/adduction

    diagonal control=internal/external/rotation

    develops with wt. bearing and reaching
  13. development of movement(continued)
    9. perception also develops in the same patterns



    perception develops with motor control

    10. control occurs first in wt. bearing positions before in space

    needs to have control in prone on elbows or extended arms before reaching

    needs to have control in sitting before freeing arms for play
  14. Reflexes grouped
    spinal level-phasic rel=flexes-birht -2month

    brainstem-tonic reflexes-birth-4/6 months

    midbrain level-righting reactions-through life

    cortical level-equilibrium reactions-through life
  15. what is a reflex?
    a specific automatic patterned response elicited by aparticular stimulus.

    it does not involve any conscious control.

    it produces a change in muscle tone and its distribution.
  16. a motor output...
    that follows some specific sensory input.

    it is performed automatically and without conscious control
  17. reflexes
    are part of normal development

    provide the control for a newborn'smovement.

    • lower center of the brain generate reflexes movements and postures. Cortex-highest level
    • brainstem-spinal level
  18. reflexes help the child to develop:
    normal muscle tone

    normalmusle power/strength

    movement of an increasingly refined and coordinated nature
  19. reflexes produce:


    CNS development
  20. Reflexes regulate the
    degree, strength, balance, and distribution of muscle tone necessary for posture andmovement.
  21. Reflexes are grouped:
    • Phasic reflex
    • observable movement in response to a touch, pressure, or movement of the body or to a sight or sound received.

    They coordinate the muscles of the extremities in patterns of either total flexion or extension

    • ex. touching a hot stove
    • trying to put their one's on and they keep pulling their leg out

    Tonic Reflex(stablilty)

    Static postural reflexes that effect changes in the distribution of muscle tone throughout the body, either in response to a change in the head and body in space or in the head in relation to the body.

    • Righting reactions
    • interact with each other and work toward the establishment of normal head and body relationship in space as well as in relation to each other.

    Equilibrium reactions

    they occur when muscle tone is normalized and provide body adaptation in response to a change in the center of gravity in the body.
  22. primitive reflex
    reflexes that appear during gestation or at birth and become integrated by 4-6months.

    they are not considered pathological or abnormal because they are present in all normal full-term newborns

    spinal level/brainstem level

  23. reactions
    reflexes that appear in infancy or childhood and remain throughtout life

    become integreated
  24. integration of reflexes
    reflexes do not disappear butmay serve as building blocks for more complex reactions.

    they are covered up by voluntary motor control.

    the reflexes may reappear under stressful conditions or as a result of damage to the brain or spinal cord.

    • higher motor skills are developed.
    • no longer need the reflex
  25. obligatory response
    the posture or movement produced when a person is dominated by a reflex

    this response is consistent and predictable and unable to be changed.

    a reflex is also considered obligatory if it persists after the age at which the reflex should have been integrated

    always bad

    no controlled movement

    ex. CP-move head and there is no other response/reflex action
  26. pathological reflex
    see reflex in older person

    they had normal motor skills and now see reflexes that are part of normal development are due to a pathological reason

    there was an injury, illness, stroke

    in adult, not referred to as a primitive reflex. he had normal reflex skills and now becuz of an illness he doesn't
  27. test position
    position in which the infant or child should be placed prior to the elicitation of the reflex or reaction
  28. to elicit
    the action of the examiner which should cause the response

    apply whatever stimulus that i'm suppose to do

    ex. touch-apply touch
  29. response
    the action of the infant or child in response to the stimulus

    what the person does (after elicit)
  30. purpose
    reason the reflex or reaction is important to normal motor development

    • related to normal development
    • Why is it related to normal development? dones it development strength, stability, movement,
  31. onset
    age of the infant or child when the reflex or reaction is normally developed

    when reflex starts to be present

    ex. birth-4 months. birth
  32. integration
    age of the indivudual at which the relfex or reaction normally becomes rreplaced by voluntary motor control

    ex. birth to 2 months. 2 months, the end range
  33. positive response
    reflex present, but not necessarily good

    if reflex is present and beyond point of integration, then that is abnormal

    normal: when the reflex in within the onset/integration timeline
  34. negative response
    the reflex is absent

    normal depends if reflex is absent within the onset/integration stage
  35. if reflex persists:
    consequences to normal motor development and
  36. if reflex persists
    consequences to normal motor development and/or possible pathological indications if a reflex or reaction persists longer than normal or if the response is obligatory

    when reflex is still present past the timeline that it is suppose to be
  37. if reflex is absent
    consequences to normal motor development and/or possible pathologoical indications if a reflex or reaction is absent or weakened

    could be good or bad

    when you want reflexes to be absent
  38. level of integration
    level of central nrevous system at which the reflex or reaction is integrated

    • the 4 levels used are:
    • spinal
    • bainstem
    • midbraqin
    • cortical